Madison Medical Center

All Charges

Charge

Type

Setting

Price

CHEANEY URINE DIP

Facility

$27.00

Service Code	CPT 81002
Hospital Charge Code	5281002
Hospital Revenue Code	521
Rate for Payer: Cash Price	$24.30

CHEMICAL CAUTERIZATION OF GRANULATION TI

Facility

$165.00

Service Code	CPT 17250
Hospital Charge Code	9817250
Hospital Revenue Code	521
Rate for Payer: Cash Price	$148.50

CHEMICAL CAUTERIZATION OF GRANULATION TI

Facility

$165.00

Service Code	CPT 17250
Hospital Charge Code	9817250
Hospital Revenue Code	521
Min. Negotiated Rate	$97.68
Max. Negotiated Rate	$409.96
Rate for Payer: Cigna Commercial HMO & PPO	$204.98
Rate for Payer: Aetna Better Health Medicaid/QHP	$180.86
Rate for Payer: Aetna Medicare Advantage	$204.98
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$97.68
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$117.81
Rate for Payer: Cash Price	$148.50
Rate for Payer: Cash Price	$148.50
Rate for Payer: Cash Price	$148.50
Rate for Payer: Cash Price	$148.50
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$162.77
Rate for Payer: Home State Health Plan Medicaid Managed Care	$193.52
Rate for Payer: Home State Health Plan Medicare Advantage	$204.98
Rate for Payer: Humana Commercial	$409.96
Rate for Payer: Humana Medicare Advantage	$204.98
Rate for Payer: UnitedHealthcare Commercial	$110.06
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$180.86
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

CHEMICAL CAUTERIZATION TISSUE

Facility

$137.00

Service Code	CPT 17250
Hospital Charge Code	5417250
Hospital Revenue Code	521
Min. Negotiated Rate	$81.10
Max. Negotiated Rate	$409.96
Rate for Payer: Aetna Better Health Medicaid/QHP	$180.86
Rate for Payer: Aetna Medicare Advantage	$204.98
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$81.10
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$97.82
Rate for Payer: Cash Price	$123.30
Rate for Payer: Cash Price	$123.30
Rate for Payer: Cash Price	$123.30
Rate for Payer: Cash Price	$123.30
Rate for Payer: Cigna Commercial HMO & PPO	$204.98
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$162.77
Rate for Payer: Home State Health Plan Medicaid Managed Care	$193.52
Rate for Payer: Home State Health Plan Medicare Advantage	$204.98
Rate for Payer: Humana Commercial	$409.96
Rate for Payer: Humana Medicare Advantage	$204.98
Rate for Payer: UnitedHealthcare Commercial	$91.38
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$180.86
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

CHEMICAL CAUTERIZATION TISSUE

Facility

$137.00

Service Code	CPT 17250
Hospital Charge Code	5417250
Hospital Revenue Code	521
Rate for Payer: Cash Price	$123.30

CHEMOTHERAPY ADMIN EA ADDITION HR

Facility

$250.00

Service Code	HCPCS 96415
Hospital Charge Code	2696415
Hospital Revenue Code	335
Min. Negotiated Rate	$64.91
Max. Negotiated Rate	$178.50
Rate for Payer: Aetna Better Health Medicaid/QHP	$64.91
Rate for Payer: Aetna Medicare Advantage	$73.56
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$148.00
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$178.50
Rate for Payer: Cash Price	$225.00
Rate for Payer: Cash Price	$225.00
Rate for Payer: Cash Price	$225.00
Rate for Payer: Cigna Commercial HMO & PPO	$73.56
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$64.91
Rate for Payer: Home State Health Plan Medicaid Managed Care	$69.45
Rate for Payer: Home State Health Plan Medicare Advantage	$73.56
Rate for Payer: Humana Commercial	$147.12
Rate for Payer: Humana Medicare Advantage	$73.56
Rate for Payer: UnitedHealthcare Commercial	$166.75
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$64.91
Rate for Payer: UnitedHealthcare Medicare Advantage	$90.00

CHEMOTHERAPY ADMIN EA ADDITION HR

Facility

$250.00

Service Code	HCPCS 96415
Hospital Charge Code	2696415
Hospital Revenue Code	335
Rate for Payer: Cash Price	$225.00

CHEMOTHERAPY ADMIN UP TO 1 HR

Facility

$1,030.00

Service Code	HCPCS 96413
Hospital Charge Code	2696413
Hospital Revenue Code	335
Rate for Payer: Cash Price	$927.00

CHEMOTHERAPY ADMIN UP TO 1 HR

Facility

$1,030.00

Service Code	HCPCS 96413
Hospital Charge Code	2696413
Hospital Revenue Code	335
Min. Negotiated Rate	$297.75
Max. Negotiated Rate	$735.42
Rate for Payer: Aetna Better Health Medicaid/QHP	$297.75
Rate for Payer: Aetna Medicare Advantage	$337.46
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$609.76
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$735.42
Rate for Payer: Cash Price	$927.00
Rate for Payer: Cash Price	$927.00
Rate for Payer: Cash Price	$927.00
Rate for Payer: Cigna Commercial HMO & PPO	$337.46
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$297.75
Rate for Payer: Home State Health Plan Medicaid Managed Care	$318.59
Rate for Payer: Home State Health Plan Medicare Advantage	$337.46
Rate for Payer: Humana Commercial	$674.92
Rate for Payer: Humana Medicare Advantage	$337.46
Rate for Payer: UnitedHealthcare Commercial	$687.01
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$297.75
Rate for Payer: UnitedHealthcare Medicare Advantage	$370.80

CHEMOTHERAPY FOR ACUTE LEUKEMIA

Facility

$80,059.65

Service Code	APR-DRG 6954
Min. Negotiated Rate	$80,059.65
Max. Negotiated Rate	$80,059.65
Rate for Payer: Aetna Better Health Medicaid/QHP	$80,059.65
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$80,059.65
Rate for Payer: Home State Health Plan Medicaid Managed Care	$80,059.65
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$80,059.65

CHEMOTHERAPY FOR ACUTE LEUKEMIA

Facility

$10,177.11

Service Code	APR-DRG 6952
Min. Negotiated Rate	$10,177.11
Max. Negotiated Rate	$10,177.11
Rate for Payer: Aetna Better Health Medicaid/QHP	$10,177.11
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$10,177.11
Rate for Payer: Home State Health Plan Medicaid Managed Care	$10,177.11
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$10,177.11

CHEMOTHERAPY FOR ACUTE LEUKEMIA

Facility

$4,206.56

Service Code	APR-DRG 6951
Min. Negotiated Rate	$4,206.56
Max. Negotiated Rate	$4,206.56
Rate for Payer: Aetna Better Health Medicaid/QHP	$4,206.56
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$4,206.56
Rate for Payer: Home State Health Plan Medicaid Managed Care	$4,206.56
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$4,206.56

CHEMOTHERAPY FOR ACUTE LEUKEMIA

Facility

$38,823.33

Service Code	APR-DRG 6953
Min. Negotiated Rate	$38,823.33
Max. Negotiated Rate	$38,823.33
Rate for Payer: Aetna Better Health Medicaid/QHP	$38,823.33
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$38,823.33
Rate for Payer: Home State Health Plan Medicaid Managed Care	$38,823.33
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$38,823.33

CHEMOTHERAPY WITH ACUTE LEUKEMIA AS SECONDARY DIAGNOSIS OR WITH HIGH DOSE CHEMOTHERAPY AGENT WITH MCC

Facility

$79,401.04

Service Code	MSDRG 837
Min. Negotiated Rate	$39,700.52
Max. Negotiated Rate	$79,401.04
Rate for Payer: Aetna Medicare Advantage	$39,700.52
Rate for Payer: Cigna Commercial HMO & PPO	$39,700.52
Rate for Payer: Home State Health Plan Medicare Advantage	$39,700.52
Rate for Payer: Humana Commercial	$79,401.04
Rate for Payer: Humana Medicare Advantage	$39,700.52

CHEMOTHERAPY WITH ACUTE LEUKEMIA AS SECONDARY DIAGNOSIS WITH CC OR HIGH DOSE CHEMOTHERAPY AGENT

Facility

$36,376.30

Service Code	MSDRG 838
Min. Negotiated Rate	$18,188.15
Max. Negotiated Rate	$36,376.30
Rate for Payer: Aetna Medicare Advantage	$18,188.15
Rate for Payer: Cigna Commercial HMO & PPO	$18,188.15
Rate for Payer: Home State Health Plan Medicare Advantage	$18,188.15
Rate for Payer: Humana Commercial	$36,376.30
Rate for Payer: Humana Medicare Advantage	$18,188.15

CHEMOTHERAPY WITH ACUTE LEUKEMIA AS SECONDARY DIAGNOSIS WITHOUT CC/MCC

Facility

$26,244.18

Service Code	MSDRG 839
Min. Negotiated Rate	$13,122.09
Max. Negotiated Rate	$26,244.18
Rate for Payer: Aetna Medicare Advantage	$13,122.09
Rate for Payer: Cigna Commercial HMO & PPO	$13,122.09
Rate for Payer: Home State Health Plan Medicare Advantage	$13,122.09
Rate for Payer: Humana Commercial	$26,244.18
Rate for Payer: Humana Medicare Advantage	$13,122.09

CHEMOTHERAPY WITHOUT ACUTE LEUKEMIA AS SECONDARY DIAGNOSIS WITH CC

Facility

$24,117.00

Service Code	MSDRG 847
Min. Negotiated Rate	$12,058.50
Max. Negotiated Rate	$24,117.00
Rate for Payer: Aetna Medicare Advantage	$12,058.50
Rate for Payer: Cigna Commercial HMO & PPO	$12,058.50
Rate for Payer: Home State Health Plan Medicare Advantage	$12,058.50
Rate for Payer: Humana Commercial	$24,117.00
Rate for Payer: Humana Medicare Advantage	$12,058.50

CHEMOTHERAPY WITHOUT ACUTE LEUKEMIA AS SECONDARY DIAGNOSIS WITH MCC

Facility

$44,340.58

Service Code	MSDRG 846
Min. Negotiated Rate	$22,170.29
Max. Negotiated Rate	$44,340.58
Rate for Payer: Aetna Medicare Advantage	$22,170.29
Rate for Payer: Cigna Commercial HMO & PPO	$22,170.29
Rate for Payer: Home State Health Plan Medicare Advantage	$22,170.29
Rate for Payer: Humana Commercial	$44,340.58
Rate for Payer: Humana Medicare Advantage	$22,170.29

CHEMOTHERAPY WITHOUT ACUTE LEUKEMIA AS SECONDARY DIAGNOSIS WITHOUT CC/MCC

Facility

$16,937.10

Service Code	MSDRG 848
Min. Negotiated Rate	$8,468.55
Max. Negotiated Rate	$16,937.10
Rate for Payer: Aetna Medicare Advantage	$8,468.55
Rate for Payer: Cigna Commercial HMO & PPO	$8,468.55
Rate for Payer: Home State Health Plan Medicare Advantage	$8,468.55
Rate for Payer: Humana Commercial	$16,937.10
Rate for Payer: Humana Medicare Advantage	$8,468.55

CHEMSTRIPS

Facility

$16.00

Hospital Charge Code	2890018
Hospital Revenue Code	271
Min. Negotiated Rate	$5.76
Max. Negotiated Rate	$11.42
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$9.47
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$11.42
Rate for Payer: Cash Price	$14.40
Rate for Payer: UnitedHealthcare Commercial	$10.67
Rate for Payer: UnitedHealthcare Medicare Advantage	$5.76

CHEMSTRIPS

Facility

$16.00

Hospital Charge Code	2890018
Hospital Revenue Code	271
Rate for Payer: Cash Price	$14.40

CHEST COMPLETE 4 (V)

Facility

$441.00

Service Code	CPT 71048
Hospital Charge Code	3271030
Hospital Revenue Code	324
Min. Negotiated Rate	$94.24
Max. Negotiated Rate	$314.87
Rate for Payer: Aetna Better Health Medicaid/QHP	$94.24
Rate for Payer: Aetna Medicare Advantage	$106.81
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$261.07
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$314.87
Rate for Payer: Cash Price	$396.90
Rate for Payer: Cash Price	$396.90
Rate for Payer: Cash Price	$396.90
Rate for Payer: Cigna Commercial HMO & PPO	$106.81
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$94.24
Rate for Payer: Home State Health Plan Medicaid Managed Care	$100.84
Rate for Payer: Home State Health Plan Medicare Advantage	$106.81
Rate for Payer: Humana Commercial	$213.62
Rate for Payer: Humana Medicare Advantage	$106.81
Rate for Payer: UnitedHealthcare Commercial	$175.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$94.24
Rate for Payer: UnitedHealthcare Medicare Advantage	$158.76

CHEST COMPLETE 4 (V)

Facility

$441.00

Service Code	CPT 71048
Hospital Charge Code	3271030
Hospital Revenue Code	324
Rate for Payer: Cash Price	$396.90

CHEST I E

Facility

$235.00

Hospital Charge Code	323208
Hospital Revenue Code	320
Rate for Payer: Cash Price	$211.50

CHEST I E

Facility

$235.00

Hospital Charge Code	323208
Hospital Revenue Code	320
Min. Negotiated Rate	$84.60
Max. Negotiated Rate	$175.00
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$139.12
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$167.79
Rate for Payer: Cash Price	$211.50
Rate for Payer: Cash Price	$211.50
Rate for Payer: UnitedHealthcare Commercial	$175.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$84.60

Know your out-of-pocket cost for care.

All Charges